Surveillance for acute cellular rejection after lung transplantation

Abstract

Acute cellular rejection (ACR) is a common complication following lung transplantation (LTx), affecting almost a third of recipients in the first year. Established, comprehensive diagnostic criteria exist but they necessitate allograft biopsies which in turn increases clinical risk and can pose certain logistical and economic problems in service delivery. Undermining these challenges further, are known problems with inter-observer interpretation of biopsies and uncertainty as to the long-term implications of milder or indeed asymptomatic episodes. Increased risk of chronic lung allograft dysfunction (CLAD) has long been considered the most significant consequence of ACR. Consensus is lacking as to whether this applies to mild ACR, with contradictory evidence available. Given these issues, research into alternative, minimal or noninvasive biomarkers represents the main focus of research in ACR. A number of potential markers have been proposed, but none to date have demonstrated adequate sensitivity and specificity to allow translation from bench to bedside.

The Roles of Tissue-Resident Memory T Cells in Lung Diseases

“…T cells are mediators of acute cellular rejection (ACR) after lung transplantation ( 105 ). The role of pulmonary T RM cells in ACR in lung transplantation remains uncertain.…”

Transbronchial Cryobiopsy Compared to Forceps Biopsy for Diagnosis of Acute Cellular Rejection in Lung Transplants: Analysis of 63 Consecutive Procedures

“…Chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), and cystic fibrosis (CF) are the most common indications for LTx according to the recent Thoracic Transplant Registry Report of the International Society for Heart and Lung Transplantation (ISHLT) [ 1 ]. Acute cellular rejection (ACR) is detected in 27% of lung transplant recipients (LTRs) within the first year after LTx and is an important risk factor for chronic allograft dysfunction (CLAD) and mortality [ 1 , 2 , 3 ]. Allograft dysfunction is the most common cause of death following LTx [ 1 ].…”

“…CLAD is defined as a substantial loss of lung function after other factors, particularly infections, have been excluded [ 2 ]. Readily accessible diagnostic procedures to detect ACR at the earliest possible occasion are crucial for post-transplant survival [ 2 , 3 , 4 ]. Bronchoalveolar lavage (BAL) is a widely accepted method for identifying an underlying infectious disease, and a differential cellularity profile in BAL might raise the suspicion of the presence of acute ACR [ 5 ].…”

Influence of mycophenolate mofetil dosage and plasma levels on the occurrence of chronic lung allograft dysfunction in lung transplants: a retrospective cohort analysis

“…In addition to lung function measure-ments, imaging of the lungs and, to a lesser extent, laboratory analyses are used for recognising and classifying chronic lung allograft dysfunction. For example, chronic lung allograft dysfunction may present with increased levels of inflammatory parameters, lymphocytes and eosinophils in the blood [9]. Bronchoalveolar lavage (BAL) as a diagnostic tool for allograft rejection is currently being explored.…”

“…BAL is also an accepted method for ruling out pulmonary infections [10,11]. Chronic lung allograft dysfunction was diagnosed when the patient showed an irreversible decrease of ≥20% in FEV1, and other causes such as heart failure, weight gain, lung infection or anastomotic complications were ruled out [2,9].…”